title: Early administration of oropharyngeal colostrum to extremely low birth weight infants.
abstract: BACKGROUND
  Human milk reduces morbidities in extremely low birth weight (ELBW) infants. However, clinical instability often precludes ELBW infants from receiving early enteral feeds. This study compared clinical outcomes before and after implementing an oropharyngeal colostrum (COL) protocol in a cohort of inborn (born at our facility) ELBW infants.
  
  
  METHODS
  This is a retrospective cohort study of inborn ELBW infants admitted to the Duke Intensive Care Nursery from January 2007 to September 2011. In November 2010, we initiated a COL protocol for infants not enterally fed whose mothers were providing breastmilk. Infants received 0.1 mL of fresh COL to each cheek every 4 hours for 5 days beginning in the first 48 postnatal hours. We assessed demographics, diagnoses, feeding history, and mortality and for the presence of medical necrotizing enterocolitis (NEC), surgical NEC, and spontaneous perforation. Between-group comparisons were made using Fisher's exact test or Wilcoxon rank sum testing where appropriate.
  
  
  RESULTS
  Of the 369 infants included, 280 (76%) were born prior to the COL protocol (Pre-COL Cohort [PCC]), and 89 (24%) were born after (COL Cohort [CC]). Mortality and the percentage of infants with surgical NEC and spontaneous perforations were statistically similar between the groups. The CC weighed an average (interquartile range) of 1,666 (1,399, 1,940) g at 36 weeks versus 1,380 (1,190, 1,650) g for the PCC (p<0.001). In a multivariable analysis with birth weight as a covariable, weight at 36 weeks was significantly greater (37 g; p<0.01).
  
  
  CONCLUSIONS
  Initiating oropharyngeal COL in ELBW infants in the first 2 postnatal days appears feasible and safe and may be nutritionally beneficial. Further research is needed to determine if early COL administration reduces neonatal morbidity and mortality.
authors.affiliation: 1 Department of Pediatrics, Duke University Medical Center , Durham, North Carolina.
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Seigel
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Ashley
authors.forename: C Michael
authors.initials: CM
authors.lastname: Cotten
authors.forename: Claudia C
authors.initials: CC
authors.lastname: Herbert
authors.forename: Beth A
authors.initials: BA
authors.lastname: King
authors.forename: Angela R
authors.initials: AR
authors.lastname: Maynor
authors.forename: Sara
authors.initials: S
authors.lastname: Neill
authors.forename: James
authors.initials: J
authors.lastname: Wynn
authors.forename: Margarita
authors.initials: M
authors.lastname: Bidegain
mesh_terms: D000284:Administration, Oral; D003126:Colostrum / Q000276:immunology*; D004750:Enteral Nutrition / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000276:immunology / Q000517:prevention & control*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D052577:Infant, Extremely Low Birth Weight / Q000276:immunology; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods; D008297:Male; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain